GOP: Millionaires More Important Than Medicare

December 6, 2010

Via Politico's Sarah Kliff, I see that the latest Republican idea for repealing health care reform is to use the "doc fix" as a political wedge.

As my colleague Jonathan Chait explains, Medicare reimbursements for physicians include an annual update that the federal government keeps postponing. Because the formula is, in effective, cumulative, allowing the update to go into effect now would result in a fairly dramatic cut in doctor reimbursement—enough, possibly, to disrupt seniors' access to care. (I'm not sure how disruptive the cut would really be, but let's leave discussion that for another time.)

Until recently, Congress has made these postponements without finding offsetting revenue or savings. But efforts to do that again over the past year have been difficult, in part because fiscal conservatives have objected (reasonably) that Congress should start finding ways to pay for it. Earlier this year, Congress passed, and President Obama signed, a very short-term extensions. But now that extension is about to run out. And, according to Kliff's reporting, some Republicans see a political opportunity. They say they won't support the doc fix unless Obama and his allies pay for it by cutting the Affordable Care Act's public health and prevention fund.

You can see why Republicans would like this approach. One of their most successful strategies on health care reform has been to pit the elderly, who already have universal health care through Medicare, against the non-elderly, who would benefit from the Affordable Care Act's subsidies and investments. (My colleague Harold Pollack has discussed the merits of the public health fund many times.) If Obama and his allies refuse to pay for the doc fix with the Affordable Care Act's public health funds, Republicans could accuse them of taking something that belongs to seniors and giving it to everybody else.

But that's just one way of looking at it. Remember, Republicans insist that Democrats agree to extend tax cuts that benefit only the very wealthiest Americans--and that they do so without offsetting revenue increases or tax cuts. I don't have the precise, one-year figures handy. But, based on official ten-year projections, those tax cuts are about twice as costly as the doc fix. In other words, if Republicans weren't insisting on tax cuts for the rich, there would be plenty of money for adjusting Medicare physician payments--and quite a bit left over for other purposes.

It's pretty simple, really: We could pay for the physician adjustment by gutting public health funds or we could pay for it by letting tax cuts for some very, very rich people go back to what they were in the Clinton era. You tell me which makes more sense.